The Medication Safety Programme aims to greatly reduce the number of New Zealanders harmed each year by medication errors in our hospitals, general practices, aged care facilities and across the entire health and disability sector.

Healthcare associated infection is one of the most frequent adverse events in health care worldwide. Up to 10 percent of patients admitted to modern hospitals in the developed world acquire one or more infections.

Maggie Spencer, Senior Quality Improvement Manager at Counties Manukau District Health Board spearheaded a project named Partners in care – working with families/whānau to encourage participation.

The project’s aims were to:

define what partners in care means and identify any barriers that exist to working in partnership with patients and family/whānau members

develop a strategy to address the key barriers to family/whānau involvement

contribute to the continued review of the current documentation

identify training and/or information requirements to support patients, families/whānau and staff to work as partners in care.

The project focussed on two surgical wards, and patients and family/whānau members were surveyed along with staff over the course of a week. As well as conducting the survey, a forum was held with patients and family/whānau members in order to develop the framework for the partners in care process.

“Initially we worked to identify the problem, and it was determined from the survey that families and whānau are not consistently part of the care team,” said Ms Spencer, speaking at the Health Quality & Safety Commission’s Quality and Safety Challenge Forum.

“We wanted to identify how we work with them as an organisation, and we also wanted to hold a forum where we could get patients and families/whānau in the room and discuss how we could support change.”

From the results of the survey and discussions at the patient forum it was discovered that 79 percent of patients wanted their family/whānau present and involved in their care decisions. The survey also highlighted that 70 percent of staff had some concerns about open ward access to family/whānau members.

Following the forum a definition of partners in care was developed and was defined as:

‘Anyone named by the patient that they want to work with them (the patient) and the health care team to help make decisions and be involved in care.’

The key concept was that partners in care are patient defined; although members of the health care team can support the patient to find a partner if necessary (for example, whānau support workers).

Several tests were carried out including the creation of patient information boards (initially only on four bed spaces), bed side telephones and bed side information with important information for visitors such as ward round times, and where kitchen and bathroom facilities can be found etc. This information is now to be developed in a pictorial format.

The charge nurse also extended the times the ward was open to visitors and found that she spent less time resolving issues for unhappy relatives.

“Our initial area of focus was to look at who is involved in the patient’s care, what facilities are available to the patient, and how we could explain the routines and general processes to both patients and family/whānau in a way that was easy to understand.

“We learnt many lessons during the course of the project including how to deal with issues around anxiety – there were several conflicts between what is law/policy, and what is the right thing to do by the patient. Using a forum as a means of engagement was great, but it was a big commitment for patients and whānau and we intend to explore other more time efficient ways to engage with them in the future.”

The next stage of the project includes further developing the key message that family/whānau are not visitors but a vital part of the care team and the development of guidance materials for staff. This work will be adopted by the newly formed Whānau Centred Care Board.